Electrosurgical bipolar vessel sealing for vaginal hysterectomies

Background

Vascular clamping of the uterine vessels and the ovarian and broad ligaments during vaginal hysterectomies is more difficult than in traditional abdominal hysterectomies. We aimed to assess the efficacy of electrosurgical bipolar vessel sealing systems (EBVS) as an adequate alternative to traditional suturing that could facilitate the accomplishment of securing the vascular pedicles.

Methods

We searched MEDLINE (1966–2013), Scopus (2004–2013), POPLINE (1973–2013), Cochrane Central (1999–2013) and Google Scholar (2004–2013) search engines, along with reference lists from all included studies.

Results

Eight randomized trials were selected, including 772 patients. We found that operative duration did not differ significantly among women treated with EBVS and those treated with traditional suture ligation (MD ?16.86, 95 % CI ?34.77, 1.05). Intraoperative blood loss on the other hand was significantly lower in the EBVS-treated group (MD ?49.47, 95 % CI ?67.60, ?31.35). There were no significant differences in intraoperative complication rates (OR 0.96, 95 % CI 0.46, 2.01), major postoperative complication rates (OR 0.61, 95 % CI 0.29, 1.32) or minor complications (OR 1.63, 95 % CI 0.67, 3.92).

Conclusion

Our meta-analysis showed that EBVS seem to produce less intraoperative blood loss during vascular clamping, without significantly lowering intraoperative time or complication rate. However, the heterogeneity of included studies preclude firm conclusions. Future studies examine consistently their safety, and cost-effectiveness, and whether the application of such units will enhance the rates of vaginal hysterectomies.